N-Terminal Fragment of Brain-Type Natriuretic Peptide (NT-proBNP) as a Prognostic Marker in Patients with Newly Diagnosed Multiple Myeloma Complicated by Dialysis-Dependent Renal Failure

Prognostic value of N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) was analyzed in patients with multiple myeloma complicated by dialysisdependent renal failure. The prospective study included 20 patients with newly diagnosed multiple myeloma. The concentrations of NT-proBNP were measured before antimyeloma chemotherapy. The median age of the patients was 67 (63-76) years. The median glomerular filtration rate was 4 (4, 5) ml/min/1.73 m². For overall survival, the area under ROC curve was 0.75 and the cut-off point was 7000 pg/ml. At median follow-up of 17.3 months, the overall survival was 76.6±14.8 and 27.3±13.4% (p=0.02) for cases with NT-proBNP levels below and above the cut-off point, respectively. There were no cases of death due to cardiovascular causes. We concluded that the increase in serum concentration of NT-proBNP>7400 pg/ml is associated with the severity of kidney damage and the risk of non-cardiac mortality.

[Immunological aspects of chronic tonsillitis]

The objective of the present study was to identify clinical and laboratory criteria for the chronization of tonsillar pathology and propose methods for immunological rehabilitation of the patients based on the investigations into specific features of the immune response in the oropharyngeal region. A total of 371 patients presenting with chronic tonsillitis (CT) and 54 practically healthy subjects were available for observations. The study materials included saliva samples in which IF-α, IF-y, slgA, IgA, IgG, and IgE levels were measured along with extracellular peroxidase activity (immunoenzyme assay) and palatine tonsil biopsies where lymphocyte subpopulations were identified in the indirect immunofluorescence reaction as well as infection with Epstein-Barr virus, herpes simplex virus, and cytomegalovirus (by PCR). Acute tonsillitis was shown to be accompanied by the activation of antimicrobial local protective factors (interferons, peroxidase system, T- and B-lymphocytes, antibody production). CT in case of infection with Epstein-Barr virus was associated with the deficiency of antiviral and antibacterial protective factors in the oropharynx (interferons, NK-cells, peroxidase activity). The possibility of immune correction using interferons, interferonogens, and bacterial lysate-based preparations is substantiated. The complicated toxico-allergic forms of chronic tonsillitis are shown to develop from the combination of insufficiency of the protective factors (IgG) and the excessive content of IgE. Substitution therapy using antibodies (immunoglobulins for intravenous administration) is proposed as the method of choice for the management of chronic tonsillitis.

[The function of palatine tonsils in pathological changes of oral mucosa and the possibilities of immunorehabilitation]

The objective of the present study was to estimate the possibility of using imudon for the treatment of chronic generalized periodontitis (CGP) in the patients presenting with various forms of chronic tonsillitis (CT) based on the results of the study of local immunity of the oropharynx. A total of 92 patients with CGP were divided into 3 groups as follows: those without pathology of palatine tonsils (PT) (group 1), cases with compensated chronic tonsillitis (group 2), and patients with periodontitis and concomitant decompensated form of CT (paratonsilitis). The results of assessment of local immunity (from the analysis of immunocytograms of the PT surface and periodontal pockets along with the data on the immunoglobulin content in mixed saliva samples and blood plasma) give evidence of the specific features of local immune responsiveness depending on the state of palatine tonsils. The changes of local immunity characteristics after the treatment suggest the efficacy of the traditional treatment of chronic generalized periodontitis in the absence of NT pathology and the necessity of its supplementation with imudon herapy in the patients with CGP and compensated form of CT.

[Tonsillar pathology. The current state of the problem]

The objective of the present study was to substantiate the indications for the surgical and medicamental treatment of chronic tonsillitis based on the results of evaluation of the function of palatine tonsils under normal and pathological conditions. Special attention is given to various aspects of pathogenesis of recurring diseases of the upper respiratory tract elucidated from the changes of local immune responses of mucous membranes to persistent viral infection involving lymphocytes of the palatine tonsils. A method for the rehabilitation of the patients presenting with chronic tonsillitis with the use of intravenous administration of immunoglobulin preparations is proposed.

[The application of immunoglobulins for intravenous administration for the combined treatment of paratonsillar abscesses]

The objective of the present study was to evaluate the possibility of using immunoglobilins for intravenous administration (IVIG) to treat the patients presenting with paratonsillar abscesses (PTA). The comparative assessment of the clinical and immunological status of 77 patients with PTA depending on the type of therapy (traditional or combined with the use of IVIG) and the occurrence of tonsillitis in the medical history (the newly diagnosed disease, frequent tonsillitis, relapses of PTA). The level s of immunoglobulins (sIgA, IgA, IgG and its subclasses, IgM, and IgE) in mixed saliva samples were determined by the immunoenzyme assay and the albumin level by the bromcresol method with the counting of relative secretion coefficients (RSC). Palatine tonsil (PT) biopsies were used to determine the absolute content of lymphocytes (Lf) that were classified into differentiation clusters (CD3, CD4, CD8, CD16, CD25, CD71, CD95, HLA-DR). The patients presenting with paratonsillar abscesses were characterized by impaired immune responsiveness of palatine tonsils manifest as reduced production of IgG (at the expense of IgG2). This reduction was especially pronounced in the cases with the burdened medical history (recurring tonsillitis and relapses of PTA). In such patients, traditional therapy resulted in suppression of the cellular component of immunity and IgG production. The treatment with IVIG increased the production of IgG antibodies in the patients with newly diagnosed tonsillitis; moreover it stimulates production of IgG and activated the T-cell component. At the same time, the administration of IVIG reduced the duration of hospital stay from 9.29±0.31 to 7.06±25 days and the number of PTA relapses. It is concluded that the low IgG content in the saliva may be an indication for tonsillectomy.

[Peculiarities of immunotherapy of inflammation of the upper respiratory tract: the results of 30-year investigations]

The results of 30 year investigations conducted at the Department of Otorhinolaryngology, Bashkir State Medical University, provide new knowledge about immunopathogenesis of acute and chronic inflammatory processes of the upper respiratory tract and oral cavity (rhinitis, sinusitis, tonsillitis, pharyngitis, laryngitis). Moreover, they create a basis for the development of new purpose-oriented methods of immunocorrection taking into consideration the severity and duration of the inflammatory process.

[Immune reactions of palatine tonsils in the patients with chronic tonsillitis and the possibilities for their immunological rehabilitation with the use of imudon]

The objective of the present study was to develop a rationale for the application of imudon (a bacterial lysate preparation)in the treatment of the patients presenting with chronic tonsillitis based on the elucidation of characteristics of local immunity in the oropharynx (determined from the results of cytograms, immunoenzyme assays for the quantitation of IgG, sIgA, IgA, and IgM antibodies, and calculation of the relative secretion coefficients). A total of 74 patients with chronic tonsillar pathology (24 children and 50 adults) were available for the observation along with 42 subjects having no tonsillar pathology with concomitant chronic bacterial rhinosinusitis. The control group was constituted by 25 practically healthy subjects. It was shown that the local application of imudon in the patients with the preserved function of palatine tonsils (in the absence of symptoms of chronic inflammation) produces the adequate response of the humoral and cellular immunity systems. In the patients with the simple form of chronic tonsillitis imudon therapy ensured statistically significant activation of congenital immunity including the phagocyte function and a tendency toward normalization of antibody formation. It is concluded that alteration of the function of palatine tonsils in the patients presenting with the toxico-allergic form (ТАФ-2) of chronic tonsillitis implies the necessity of surgical treatment (tonsillectomy).

[Immunopathogenesis of chronic inflammatory diseases of the pharynx]

The objective of the present study was to develop indications for immunological rehabilitation of the patients presenting with chronic laryngitis. Immunogenetic characteristics (including both local and systemic immunity) were elucidated in 54 practically healthy subjects and 110 patients with catarrhal, hyperplastic, and atrophic forms of chronic laryngitis. PCR-diagnostics was performed for the presence of herpes-viruses in conjunction with bacteriological studies. It was shown that the efficacy of the effector protective factors of the immune system (including its phagocytic and T-cell components) was insufficient to suppress the persistent Epstein-Barr virus infection combined with staphylococcal and streptococcal infections. The protection of laryngeal mucosa depended on the involvement of proinflammatory antibodies (IgE and IgG) in the inflammatory process and the severity of defects in the elimination mechanisms (affecting the phagocytic component and secretory antibodies). The compromised protective function created conditions for the long-term persistence of pathogens.

[The application of the rhinocytological technique for diagnostics of infectious and allergic rhinitis and sinusitis]

The objective of the present study was to estimate the informative value of the cytological investigation of nasal secretion in the children presenting with infectious and allergic rhinitis and sinusitis. This publication presents the results of comparative analysis of rhinocytograms obtained from the patients with the above diseases. It was shown that the rhinocytological technique can be applied for differential diagnostics of rhinitis and sinusitis in the children, the assessment of the severity of allergic diseases of the upper respiratory tract, and monitoring the efficacy of the treatment of rhinitis.

[The role of interleukin 1-beta in pathogenesis and treatment of recurrent suppurative rhinosinusitis]

The objective of the present work was to study specific immunogenetic characteristics of 1-beta interleukin (IL 1-beta) production and estimate the possibility of using recombinant IL 1-beta for the treatment of recurrent suppurative rhinosinusitis. It was shown that the low production of IL 1-beta attributable to the combination of genotypes +3953>T *C/*C and -511C>T *C/*TAND *t/*t is associated with a relapse of suppurative rhinosinusitis. The patients presenting with this disorder are in need of dispensary examination and repeated administration of recombinant IL 1 beta (betaleukin) during the period of exacerbation of suppurative rhinosinusitis.

[Pharmacopuncture in combined treatment of children with neurosensory hypoacusis]

Pharmacopuncture treatment (cerebrolysin, cavinton, prozerin) was given to 120 children with neurosensory hypoacusis aged 4-15 years. The treatment consisted of 3 courses 10 days each with 7-10-day interval. The drugs were injected in the dose 0.1 ml in biologically active points according to the original technique. The treatment lowered tonal thresholds more than by 15 dB in 36% children. Speech intelligibility increased, head ache and nose in the ears relieved in 85% cases. Adaptation to the hearing aid was positive. Clinical evidence was confirmed by REG picture indicating normalization of hemodynamics. Pharmacopuncture is a promising method in the treatment of children with neurosensory hypoacusis.

[Indications to tympanotomy at early stages of exudative otitis media]

82 patients with exudative otitis media were treated surgically. Tympanotomy with revision of the auditory tube, retrotympanum and hypotympanum accompanied with reconstruction of the tympanic cavity was conducted. The effect of the surgery was the highest in early disease (3.5-6.5 weeks).

[Immunologic correctors in combined treatment of paratonsillitis]

As shown by immunological examination of 47 healthy subjects living in polluted territories and 120 patients with paratonsillitis (PT), PT arises in T-cell and humoral immunodeficiency of the palatine tonsils. Conventional treatment fails to eliminate initial immunodeficiency, contributes to development of chronic inflammation and complications. Adjuvant treatment with local polyvalent pyobacteriophage and parenteral placental albumin improves local and systemic immunity, promotes a favourable outcome of acute inflammation in the tonsils.

[Validation of therapeutical policy choice in exudative otitis media]

132 patients with diagnosis acute or subacute exudative otitis media were treated conservatively (n = 79) or surgically (n = 53). Conservative treatment was effective in 41% of the cases, surgical treatment produced positive results in 62.3%. The operative treatment combined elements of endoscopic nasal surgery and methods used in tympanoplasty, plastic treatment of the auditory tube, surgery of the internal ear.

[Comparative evaluation of surgical methods for treating chronic frontal sinusitis]

Life-time microscopy of the mucosal scrapings was performed in diverse periods after surgical treatment of chronic frontal sinusitis to study the condition of the mucosa in the area of frontonasal anastomosis. The causes of frontal sinusitis recurrences were analyzed in respect to method of surgery used: shunting, functional endoscopic frontoethmoidotomy and conventional surgery with external approach. The main cause of the recurrences was functional incompetence of the frontonasal anastomosis as a result of persistent inflammation of the anterior cells of theethmoidal labyrint and due to anatomic anomalies of the nasal lateral wall. The best outcomes were observed after functional endoscopic frontoethmoidotomy. Conventional surgery with external approach brought about the greatest number of recurrences (30.3%).

[Mechanisms of lesions of nasal mucosa microcirculation in allergic rhinitis]

Morphological study of tissue of the mucous membrane of the nasal cavity in 36 patients which was removed in the process of surgical treatment showed a marked disorder of microcirculation. Immunoluminescent studies revealed fixed globulins and a complement in the vascular wall.